Declining Access to Physician Services Not Just a Medicare Problem

ASHINGTON, D.C.—A growing proportion of Medicare beneficiaries and older privately insured people are having problems accessing medical care and experiencing long waits for physician appointments, according to a study released today by the Center for Studying Health System Change (HSC).

"Americans of all ages are having more trouble seeing a doctor—reduced access to physician services is not just a Medicare problem; its a system-wide problem," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.

Congress is currently considering whether to increase Medicare physician payment rates after doctors protested a 5.4 percent average payment cut in January. However, access problems began while Medicare payments to doctors were rising. Left unchanged, Medicares payment formula would further reduce physician payment rates over the next several years.

The study found that the extent and type of access problems experienced by both Medicare seniors and privately insured Americans aged 50 to 64 varies across communities. These problems may be due to such non-Medicare factors as patients demand for services, changes in private insurance, the number and type of available physicians and other local market conditions.

"The question for Congress is whats the tipping point for compromising physicians willingness to care for Medicare patients," Ginsburg said. "Additional Medicare cuts of the magnitude expected over the next few years are likely to increase beneficiaries access problems, especially in markets where private insurers pay significantly more than Medicare for physician services."

The studys findings are detailed in a new HSC Issue Brief—Growing Physician Access Problems Complicate Medicare Payment Debate. Ginsburg is a co-author of the study by HSC Senior Researcher Sally Trude, Ph.D.

Delays in getting appointments with surgical and medical specialists were a particular problem for Medicare seniors and older privately insured people in 2001, with roughly half of both groups waiting more than three weeks for a checkup with a specialist and almost three in four waiting more than a week when ill to see a specialist. While average Medicare payment rates for all physicians grew from 1998 to 2002, some surgeons saw double-digit cuts over that period.

Three key measures of physician access are whether patients delay or do not get needed care, whether patients can get a timely appointment and whether doctors are taking new patients. An analysis of HSCs national Household and Physician Surveys shows access problems are increasing for both Medicare beneficiaries and older privately insured people. For example:

The percentage of Medicare seniors reporting delaying or not getting needed care rose from 9.1 percent in 1997 to 11 percent in 2001. At the same time, the percentage of older privately insured people who reported access problems increased from 15.2 percent to 18.4 percent.

Both Medicare seniors and older privately insured people are waiting longer for physician appointments. For example, 40.3 percent of Medicare seniors in 2001 had to wait a week or longer for an appointment when they were sick, up from 34.6 percent in 1997. In comparison, 36.3 percent of older privately insured people in 2001 had to wait a week or longer for an appointment, up from 29.9 percent in 1997.

The proportion of physicians accepting all new Medicare patients declined from 74.6 percent in 1997 to 71.1 percent in 2001. At the same time, the proportion of physicians accepting all new privately insured patients of any age declined from 70.8 percent to 68.2 percent.

Along with identifying national trends, the HSC study examined access to physician services in 12 communities and found that local access problems cannot be captured with a single measure, such as physicians willingness to accept all new Medicare patients.

For example, in Seattle, 71 percent of physicians in 1997 were willing to accept all new Medicare patients, but in 2001, only 55 percent were willing. Despite this drop, Seattle still ranked highly on other measures of access to care, with only 8 percent of Medicare beneficiaries saying they delayed or did not get needed care in 2001, compared with 15 percent or more in Cleveland, Indianapolis, Miami, Phoenix and Orange County, Calif.

Seattle Medicare beneficiaries also were less likely to face appointment delays. About 24 percent of Medicare beneficiaries in Seattle faced a delay obtaining a checkup, compared with 55 percent or more in Boston and Syracuse, N.Y. And 55 percent of Seattle Medicare beneficiaries had to wait for an appointment when they were ill, compared with 70 percent in Boston. Interestingly, Boston ranks among the highest of the 12 markets in physician willingness to accept all new Medicare patients.

"Given the complexity of local health markets, isolating the effect of changes in Medicare physician payment rates on beneficiary access is difficult," Trude said. "Monitoring only Medicare beneficiaries may overlook system-wide problems, national indicators may miss local factors and surveys of a single stakeholder, such as physicians, may not give the full picture."

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded exclusively by The Robert Wood Johnson Foundation and affiliated with Mathematica Policy Research, Inc.